Page 123 - Lean six sigma demystified

102 Lean Six Sigma DemystifieD

• Why? Because the patient is idle, waiting on the next step in his or her
diagnosis or treatment.
• Why is the patient waiting? Because the steps in his or her care haven’t
been linked up to eliminate delays.
• Why haven’t the patient been linked up? Because no one is measuring
and monitoring the time it takes for each step to get started.
Everybody seems to know how long it takes to do their job. It takes bed
management 5 to 10 minutes to assign a bed, assuming one is available. It
takes 15 to 20 minutes to transport a patient to a bed. It takes housekeeping
22 minutes to clean an ICU or medical/surgical bed. The ED triage nurse
takes only a few minutes to evaluate a patient. The ED doctor only takes a
few minutes to examine the patient.
But nobody knows how long the delays are between each of these steps.

Rule 2. Start measuring the delays between steps in the patient’s care, because
this is how LOS increases and patient satisfaction decreases.

INsIGHt 2 Walking is waste!

Any amount of time that a doctor or nurse or technician spends walking is
waste. Reduce the distance he or she travels, and it will improve patient satisfac-
tion and outcomes.

INsIGHt 3 Speed is critical to patient satisfaction!

Unfortunately, current hospital management practices discourage accelerating
patient flow. The staff worries that if you move patients too quickly, they might

have to send nurses home because of empty beds. Nurses depend on their
income just like the rest of us, so they think they are actually being punished if
they reduce patient delays.
As Robert Wood Johnson Hospital discovered, however, faster patient flow
leads to more jobs, not fewer. Patients are smart; they can tell a faster hospital
from a slower one.
Some of the clinical staff thinks that accelerating patient flow means making
the clinicians work faster or harder. But accelerating patient flow has little to do
with clinicians; it has to do with reorganizing the work to get faster patients.
The clinical staff also worries that haste makes waste, that faster turnaround
times will lead to poorer outcomes, but that’s only true if the clinician hurries.
Accelerating patient flow isn’t about making clinicians faster; it focuses on